Surgery 8 Flashcards
What are the benefits of Hickman lines over PICC lines?
PICC lines are not suitable for all medications
PICC lines block more easily
PICC lines may cause clots in your arm
What are the features of Leriche syndrome?
Buttock claudication and wasting
Erectile dysfunction
Absent femoral pulses
NOTE: caused by aorto-iliac insufficiency
List some complications of TURP.
IMMEDIATE: TURP syndrome, haemorrhage
EARLY: haemorrhage, infection, clot retention (requires bladder irrigation with 3-way catheter)
LATE: retrograde ejaculation, erectile dysfunction, incontinence, urethral stricture, recurrence
What are the advantages and disadvantages of suprapubic catheterisation?
ADVANTAGES: reduced risk of UTI, reduced risk of stricture formation, patient preference, maintain sexual function
DISADVANTAGES: more complex, risk of serious complications (viscus perforation, haemorrhage, malignancy seeding)
NOTE: contraindicated if suspected bladder cancer, undiagnosed haematuria or previous lower abdominal surgery (adhesions)
What are the main types of testicular tumour?
Seminomatous (50%)
Non-Seminomatous: teratoma is most common
Yolk sac tumour (most common in children)
Leydig or Sertoli cell tumour (may produce oestrogens)
Lymphoma (NHL is most common testicular mass in > 60 yrs)
Outline the surgical management of inguinal hernias.
Open surgery: Lichtenstein tension-free mesh, Shouldice suture repair
Laparoscopic: TEP or TAPP repair
TEP: totally extraperitoneal (peritoneum not incised)
TAPP: transabdominal pre-peritoneal (peritoneum incised)
NOTE: laparoscopic is better for bilateral hernias, no mesh needed in children
List some conditions that cause lipomas.
Dercum’s disease - multiple painful lipomas, peripheral neuropathy, obesity
Familial multiple lipomatosis
Madelung’s disease (multiple symmetric lipomatosis - mainly causes symmetrical lipomas on shoulders)
Bannayan-Zonana syndrome
What is a cholesteatoma?
In-growing stratified squamous epithelium of the ear drum within the middle ear
Leads to chronic foul discharge, hearing loss, facial nerve damage and vertigo
Can lead to deafness, meningitis and brain abscess
What are the borders of the femoral canal?
Medial: lacunar ligament
Lateral: femoral vein
Anterior: inguinal ligament
Posterior: pectineal ligament
NOTE: contains fat and Cloquet’s node (femoral nerve, artery and vein are lateral to the femoral canal)
What are the indications for immediate CT head scan (within 1 hour) in patients who have had a head injury?
GCS < 13 on initial assessment
GCS < 15 at 2 hours post-injury
Suspected open or depressed skull fracture.
Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
Post-traumatic seizure.
Focal neurological deficit.
More than 1 episode of vomiting
List some causes of shoulder pain with or without reduced range of motion.
Rotator cuff tear/tendonitis Subacromial bursitis Adhesive capsulitis (frozen shoulder) Synovitis Osteoarthritis Dislocation Fracture of the humeral head Referred pain from the diaphragm
Which operations are likely to require a loop colostomy?
RUQ: defunctioning transverse colostomy to cover a distal anastomosis (RARE)
LIF: apex of sigmoid exteriorised without resection for inoperable colorectal cancer that is likely to obstruct
List some differentials for midline neck masses.
Thyroid isthmus mass
Inclusion dermoid cyst
Thyroglossal cyst
What is a dermoid cyst?
Epidermal-lined cyst deep in the skin
Congenital (inclusion cyst) - forms along lines of skin fusion (e.g. midline neck, lateral eyebrows)
Acquired/implantation cyst - often secondary to piercing
What does the McMurray test look for?
Meniscal tears
EPONYMOUS OPERATIONS: pyloric stenosis
Ramstedt pyloromyotomy - longitudinal incision through muscularis propria at pylorus
What is the main indication for abdomino-perineal resection?
Tumours lying within 4-5 cm of the anal verge
List some complications of mechanical ventilation.
Pneumothorax
Fluid retention
Ventilator-induced lung injury
Ventilator-associated pneumonia
Outline the management of Dupuytren’s contractures.
Non-Surgical: physiotherapy, steroid injections, allopurinol
Surgical: fasciotomy, partial fasciectomy (Z-plasty), arthrodesis
List some complications of carpal tunnel decompression surgery.
Hypertrophic and keloid scars
Scar tenderness
Nerve injury (palmar cutaneous branch of median nerve, motor branch to thenar muscles)
Failure to relieve symptoms